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AVITA PHARMACY 1037
CH042430 THE COASTAL FAMILY HEALTH CENTER INC
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Covered Entity Details
Entity Name
THE COASTAL FAMILY HEALTH CENTER INC
Subdivision Name
COASTAL FAMILY HEALTH CENTER CORPORATE OFFICE
Type
HRSA-Funded Health Center
340B ID
CH042430
Entity Address
10467 Corporate Drive
Gulfport, MS 39503
Grant Number
H80CS00188
Participating Start Date
7/1/1999
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1037
Pharmacy Address
AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC
2519 CANAL ST
NEW ORLEANS, LA 70119
Pharmacy Comments
Contract Details
Approval Date
1/7/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angel Greer, Executive Director
(228) 374-2424
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, FOUNDER
(504) 905-4587
Signed By Date
1/7/2014
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